Recessive Epidermolysis Bullosa simplex- A case report

Background:Epidermolysis bullosa simplex (EBS) is characterized by intraepidermal blister formation, most commonly appearing in early infancy. Many variants of EBS exist; the four most common variants are inherited in an autosomal dominant fashion. The recessive forms are rare and less reported in our environment. The objective of this report is to describe the case of a young boy with a rare, recessive variant of EBS born to first-cousin parents. Method: The case records of a twelve-year old Nigerian male being managed at the dermatology clinic of Aminu Kano Teaching Hospital (AKTH), Kano was reviewed. Relevant clinical photographs with informed consent and review of literature were carried out. Results: A 12 year old Nigerian male, product of consanguineous marriage presented to the dermatology clinic with recurrent blistering of the skin since early childhood. The areas of the skin commonly affected include the knees, ankles, wrists and elbows with seasonal variations in the severity of lesions. His immediate younger brother is said to have similar skin lesions. Physical examination and histology were in keeping with EBS. Conclusion: Recessive EBS though rare, does occur in our environment and should be suspected in males with blistering skin conditions that are products of consanguineous marriage. Key words: Epidermolysis bullosa simplex, consanguinity, skin blisterin

Relationship Between the 6-minute Walk Test and Correlates of Type 2 Diabetes: Indication for caution in exercise prescription

Physical exercise is adjudged effective in the prevention and co-management of Type 2 diabetes (T2D). However, because of the different levels of exercise capacity; it must be prescribed with caution based on the individual’s peculiarities. The link between the 6-minute walk test and some correlates of T2D was investigated. This cross-sectional study of 58 consenting patients with T2D was conducted at the diabetes clinic of a secondary health centre in Kano, Nigeria. The measurements included the 6-Minute Walk Distance (6MWD) for exercise capacity and the T2D correlates including age, body mass index, waist circumference and waist-hip ratio. The relationships between the parameters were determined using the Pearson’s correlation coefficient at a significance level of 0.05. The participants consisted of 36 males (62.1%) and 22 females (37.9%). The mean 6MWD for males was 302 ± 33.28 meters and was shorter in women. The 6MWD correlated significantly (P < 0.05) with each of age [r = -0.78 (males), -0.62 (females)], waist circumference [r = -0.82 (males), -0.77 (females)] and body mass index [r = -0.66 (males), -0.74 (females)], while the waist hip ratio correlated significantly with the 6MWD only in the male participants (r = -0.59). Low exercise capacity in patients with T2D was associated with higher age and adiposity. Prescription of physical exercise to patients with T2D who present with one or a combination of these variables should be done with care in order not to exceed safe limits. KEY WORDS: type 2 diabetes, physical exercise, age, body mass index, waist circumference and waist-hip rati

Increase in Adiposity of Type 2 Diabetes Patients following Withdrawal from Therapeutic Exercise

In order to achieve optimum health status, Type 2 Diabetes (T2D) patients are usually encouraged to undergo regular and consistent therapeutic exercises. This study investigated whether the gains of exercises on adiposity variables of T2D patients are maintained within a few weeks of withdrawal from exercise and whether it was significantly related to the age of the patient and the duration of diagnosis of T2D. Forty-three T2D patients aged between 30 and 64 years were recruited for this study. They were placed on a combination of endurance and strengthening exercises for 12 weeks. The participants were thereafter observed for another 12 weeks without exercises. The adiposity variables measured in both phases of the study include: body mass index (BMI), waist circumference (WC), waist-hip-ratio (WHR) and percent-body-fat (PBF). Significant improvements (P less than 0.05) for all the variables were achieved after 12 weeks of therapeutic exercises. The variables, however, showed significant relapses (P less than 0.05) within six weeks of withdrawal of exercise and these were significantly related (P less than 0.05) to both the age of the patient and the duration of diagnosis. The endurance and strengthening exercises improved the adiposity variables of theT2D patients, but the gains began to decline within six weeks of withdrawal from the exercises. The increase in adiposity was more as the age and duration of diagnosis of the patients increased. KEY WORDS: weight maintenance, body composition, diabetes mellitu

Case Report - Histoplasmosis: An elusive re‑emerging chest infection

An immunocompetent patient presenting with disseminated histoplasmosis and superior vena cava obstruction. Features at presentation were in keeping with tuberculosis. Histology of bronchoalveolar lavage specimen clinches the diagnosis of histoplasmosis

New-onset diabetes after renal transplantation: A case series as seen in a Nigerian kidney transplant population

New-onset diabetes after transplantation (NODAT) is an important metabolic complication of transplantation because of its associated morbidity and mortality. Risk factors for NODAT include those known to cause diabetes mellitus in non-transplant patients as well as transplant-specific factors. This study was aimed at illustrating the presentationand management of NODAT in three kidney transplant recipients in our center and reviewing the literature. To our knowledge, this is the first report from Nigeria. Two of the patients were males of ages 60 and 36 years, respectively, while the third was a female aged 25 years. They were all receiving prednisolone, two were on tacrolimus, and one was on cyclosporine as part of their immunosuppressive regimens. They developed NODAT at varying times post transplant, ranging from 3 months to 6 years. Two patients were managed with oral hypoglycemic agents and one with insulin. One patient died of hemorrhagic stroke. We conclude that NODAT occurred in our kidney transplant recipients and recommend that physicians should have a high index of suspicion in order to make an early diagnosis and institute appropriate management to reduce morbidity and mortality.Key words: New-onset diabetes, Nigerians, renal transplan

Prevalence of metabolic syndrome among apparently healthy adults in a rural community, in north-western Nigeria

Background: Metabolic syndrome (MetS) is a cluster of multiple metabolic abnormalities that increases the risk of cardiovascular morbidity and mortality, and a resultant severe economic implication.This study assessed the burden of MetS in a Nigerian rural community setting.Method: This was a cross-sectional, community based study on apparently healthy subjects.A multi stage cluster sampling technique was employed to recruit the study subjects.A standardized pre-tested questionnaire was used to obtain data, and blood samples from subjects were analysed using standard laboratory techniques. MetS was defined using the NCEP-ATP3 criteria. Data were analysed using STATA version 11, and a p value of &lt;0.05 was considered statistically significant.Results: A total of 450 subjects completed the study, with 38% being males, and a mean age of 40.27±16.41 years. MetS was found in 116 (25.78%) of the subjects.Of these, systemic hypertension was found in 91(78.45%), while all (116) had elevated cholesterol and triglycerides.Abdominal adiposity was found in 45 (38.79%) subjects and 44 (37.93%) had Type 2 diabetes mellitus.Conclusion: The prevalence of MetS and its components in our studied population was high; hence the need for further large population based studies to determine its predictors in our environment

Prevalence of Overweight and Obesity in Maiduguri, North-Eastern Nigeria

BACKGROUND: The prevalence of obesity is on the increase worldwide including in many developing countries. There is no report on the magnitude of obesity among adults in Maiduguri, a major city in northeastern Nigeria.MATERIALS and METHODS: We selected a sample of 1650 men and women aged 15 years and above resident in Gwange ward in Maiduguri metropolitan council using a multistage sampling technique. Height, weight, waist (WC) and hip circumferences were measured. Body mass index (BMI) and waist-to-hip ratio (WHR) were calculated. Data were analyzed using SPSS version13. The ethics committee of the Universityof Maiduguri Teaching Hospital approved the study and consent was sought individually from the participants before being enlisted.RESULTS: The mean (SD) age of the respondents was 36.2 (14.4) years, with a range of 15 to 70 years. The mean (SD) ages of the males and  females were 34.9 (14.3) and 38.9 (14.0) years, respectively, (p&lt;0.001). The overall crude prevalence rates of overweight and obesity were 27.1% and 17.1%, respectively. In men, 40.6% were either overweight or obese, while in women 51.9% were either overweight or obese. We observed thehighest prevalence rates of overweight and obesity in the middle age group. There were more obese females than males (14.05 vs. 4.3%) among both young and elderly (12.1% vs. 10.5%) subjects.CONCLUSION: The prevalence of overweight and obesity is high in Maiduguri metropolis particularly among women. Concerted efforts should be made to curb the menace of increasing rate of obesity in the metropolis through public enlightenment on the risks associated with obesity and the benefits of adopting a healthy lifestyle.KEY WORDS: Overweight, Obesity, Prevalence, Maiduguri

Prevalence of obesity and ethno-geographic variation in body sizes of Nigerians with type 2 diabetes mellitus - a multi-centre study

BACKGROUND: Excess weight gain is common in people with type 2 diabetes mellitus (DM) but little is known about its ethno-geographic variation among the Nigerian populace. We aimed to report the prevalence and regional variation of overweight/obesity among subjects with type 2 DM in all the six geo-political regions of Nigeria.METHOD: Basic demographic and anthropometric data were consecutively collected from patients with type 2 DM attending out-patient clinics of seven designated teaching hospitals in the six geographic regions of the country using a pre-agreed method of measurement of anthropometry including waist circumference. The study was hospital-based descriptive cross-sectional in design. Body Mass Index (BMI) was categorised using the WHO criteria. Based on recommendations of the International Diabetes Federation (IDF) cut-off values for waist circumference, values &gt;94 cm and &gt; 80 cm were taken as abnormal for men and women respectively.RESULTS: A total of 709 subjects with DM comprising 378 (53.3%) females and 331 (46.7%) males (female: male ratio 1:1.14) with an overall mean age (SD) of 51.9 (13.9) years were evaluated. The prevalence of excess body weight among Nigerian subjects with type 2 DM was: peripheral (417 or 58.8%) and abdominal obesity (449 or 63.3%). Also, there was a significant wide variation in excess weight gain (both peripheral and central) across ethno-geographic regions (p=0.001) and between both sexes (p=0.001). In both peripheral and abdominal obesities, whether intra or inter centres, the female subjects with type 2 DM demonstrated relatively higher proportions of anthropometric measures. Generally, subjects from south-south and south-east Nigeria had higher BMI and abdominal obesity compared to those from south-west who had the lowest. The female subjects with type 2 DM were heavier peripherally and centrally compared to their male counterparts.CONCLUSION: The prevalence of peripheral and central obesity among Nigerians living with type 2 DM (especially the female subjects) is unacceptably high. Additionally, there is a wide variation in the proportion and absolute values of both peripheral and central obesity across different parts of Nigeria.KEY WORDS: Obesity, Prevalence, Ethno-Geographic Variation, Nigerians, Type 2 Diabetes Mellitu

Verrucous (Hypertrophic) Cutaneous Lupus Erythematosus: A Case Report

Verrucous (Hypertrophic) Lupus Erythematosus (LE) represents a rare but distinct, variant of chronic discoid lupus erythematosus. We report a case of LE with verrucous lesions for its rarity and peculiar location posing a diagnostic dilemma

Dyslipidemia: Prevalence and associated risk factors among patients with Lichen Planus in Kano, North-West Nigeria.

Background: Lichen planus (LP) is a chronic inflammatory disorder. Recently, there are suggestions that LP is associated with dyslipidemia in a large series of patients independent of other causes  Objective: The objective of this study was to investigate the prevalence and associated risk factors for dyslipidaemia among patients with LP. Methods: This case-control study included 180 subjects, 90 with lichen planus (39 men and 51 women) and 90 (44 men and 46 women) controls consecutively recruited from the outpatient Dermatology clinic of Aminu Kano Teaching Hospital Kano- Nigeria Results: The prevalence of dyslipidemia was found to be higher among LP patients (32%) than the control group (24%), p=0.208. Our study showed that male patients with LP have higher tendencies to develop dyslipidemia (OR 5.66, CI 1.73-19.59). Equally the duration of illness ≥ 2months was found to be a strong predictor of developing dyslipidemia (OR 5.65, CI 1.12-38.3). No significant differences were observed in glucose levels, body mass index, or blood pressure between the two study groups. Conclusion: The prevalence of dyslipidaemia among patients with LP in this study was high with male gender and increased duration of illness being strong predictors. There is need for further studies on a larger scale to establish the prevalence and independent predictors of dyslipidaemia in patients with LP in our setting.Keywords: Dyslipidaemia, Lichen Planus, Kano, North- Western Nigeri